Facility Evaluation Report

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Program Manager (PM) Belinda Sibal, and explained the purpose of the visit.

LPA Valerio observed three (3) staff on shift and two (2) residents present in the facility. LPA Valerio and PM Sibal toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed common areas to be fully furnished, clean, organized, and free from odors. LPA Valerio observed resident bedrooms to be clean, fully furnished, free from odors, and personalized to each resident's interest. LPA Valerio observed resident bathrooms. The hot water was measured to deliver hot water at 115.0 degree F. The garage was observed to have an extra supply of food and hygiene supplies. The kitchen area was observed to be sanitary and have working appliances. LPA Valerio observed fresh fruits and vegetables on the kitchen counter. The facility was observed to a minimum of two day supply of perishable food item and seven day supply of non-perishable food items. LPA Valerio observed the staff and residents getting ready for an afternoon outing. LPA Valerio observed the exterior area to have no emergency exits obstructed. LPA Valerio observed the fire extinguisher, carbon monoxide detectors, and fire detectors to be in working condition.

LPA Valerio observed two resident files and two staff files. All files were observed to be up to date with required annual documentation. LPA Valerio requested the following be sent to christina.valerio@dss.ca.gov: LIC 500, LIC 308, LIC 610, and copy of surety bond.

Per California Code of Regulations (CCR) - Title 22 - no deficiencies were observed today. An exit interview was held, and a copy of this report was provided.